Usefulness of indocyanine green fluorescence imaging: A case of laparoscopic distal gastrectomy after distal pancreatectomy with splenectomy

Safe preservation of the remnant stomach during distal gastrectomy in patients who have undergone distal pancreatectomy is important. During distal pancreatectomy, the splenic artery that supplies arterial blood to the cardiac part of stomach is resected. Previous reports suggested that blood flow to the remnant stomach may be insufficient when supplied by only the left inferior phrenic artery. In the present case, a 79‐year‐old woman who underwent distal pancreatectomy with splenectomy 20 years before she was diagnosed with gastric cancer and referred to our hospital. We performed laparoscopic distal gastrectomy and Roux‐en‐Y reconstruction because preoperative CT scan indicated a developed left inferior phrenic artery. To evaluate the blood supply, we employed indocyanine green fluorescence and were able to safely preserve the remnant stomach. Our experience suggests that indocyanine green fluorescence is potentially useful for evaluating blood flow to the remnant stomach.     

联合脾动脉干及脾切除在进展期胃底贲门癌根治术中的意义

目的探讨进展期胃底贲门癌D2根治术联合脾动脉干及脾切除术对患者预后的影响。方法回顾分析2000～2006年106例进展期胃底贲门癌No10、Noll组淋巴结转移情况,以及对比采用D2根治术与D2根治术联合脾动脉干及脾切除术后的随诊情况。结果本组病例均为进展期胃底贲门癌,D2根治术组58例,其中中分化腺癌14例,低分化腺癌32例,黏液腺癌12例。Pr222例,PT335例,PT43例,术后5年生存率24．1％（14／58）;D2根治术联合脾动脉干及脾切除术组48例,其中中分化腺癌10例,低分化腺癌29例,黏液腺癌8例,鳞癌1例,PT218例,P丁326例,PT44例,Nol0转移8例（16．7％）,Noll转移9例,术后5年生存率39．6％（19／48）。结论进展期胃底贲门癌在D2根治术基础上联合脾动脉干及脾切除可椹高患者术后毕存摩．     

残胃癌的临床特征及外科治疗

目的探讨残胃癌的临床特征及治疗方法.方法回顾分析2000年1月至2010年12月上海新华医院普外科收治的32例残胃癌患者的临床资料.结果 32例患者确诊残胃癌距首次手术时间平均为21年;初次手术行Billrotn II式胃大部切除术24例;残胃癌发生在吻合口18例;残胃手术切除率为73.3%.结论 残胃癌大多发生于初次胃部分切除术后10年以上,多发生于Billroth II术式,癌病变主要位于吻合口附近.早期诊断、早期治疗,根治性手术是残胃癌的有效治疗方法.     

术中动脉灌注化疗于胃癌根治术中的应用研究进展

胃癌发病率死亡率均较高,早期胃癌行根治性切除术后复发转移率较低,但进展期胃癌（AGC）即使行R0切除术后复发转移率仍较高,究其原因为外科手术治疗无法根除肿瘤微转移灶。术中动脉灌注化疗（IAIC）能使肿瘤及肿瘤周围组织形成高化疗浓度场所,杀灭外科根治术后残留癌细胞。对AGC行肿瘤R0切除加D2淋巴结清扫配合IAIC能达到宏观及微观上的根治,降低肿瘤的复发转移概率,延长患者生存时间,提高生存质量。IAIC起源于20世纪90年代,经过近30年的发展,其临床效果已得到认可,但缺乏相关大宗随机试验证据支持,其灌注血管选择、用药方案选择等仍未得到规范。本文就IAIC的研究现状做一综述,为相关临床工作提供参考。     

远端胃癌患者行微创手术结合三角吻合的长期预后研究

目的探讨全腹腔镜下远端胃癌根治术(TLDG)加三角吻合(DA)治疗远端胃癌的长期疗效。方法回顾性收集2014年1月-2016年4月于浙江衢化医院行腹腔镜远端胃癌根治术治疗的128例远端胃癌患者的临床资料。根据手术方式的不同,分为TLDG加DA治疗组(DA组,72例)和腹腔镜辅助下远端胃癌根治术(LADG)加管状吻合(TA)治疗组(TA组56例)。记录两组手术时间、术中出血量、拆线时间、术后排气时间、淋巴结清扫数目、住院时间和术后并发症情况。采用电话随访的形式每个月定期随访,随访截至2017年4月。结果 DA组术中出血量(55.6±12.5)ml和术后排气时间(2.5±1.0)d均明显低于TA组的(85.6±15.8)ml和(4.5±1.5)d,差异有统计学意义(P0.05),两组手术时间、拆线时间、淋巴结清扫数目和住院时间比较差异均无统计学意义(P0.05)。DA组吻合口狭窄(0.00%)、吻合口瘘(0.00%)和吻合口出血(0.00%)发生率明显低于TA组的7.14%、8.93%和7.14%,差异有统计学意义(P0.05)。DA组全部获得有效随访,随访时间16~62个月,16例患者死于肿瘤复发或转移,累积生存率77.78%。TA组全部获得有效随访,随访时间15~61个月,14例患者死于肿瘤复发或转移,累积生存率75.00%。DA组和TA组累积生存率比较差异无统计学意义(P0.05)。结论在远端胃癌的治疗中,与LADG加TA相比,采用TLDG加DA近期疗效存在一定的优势,但两者远期疗效相当。     

两阶段法远端胃切除+D2淋巴结清扫在胃窦癌根治术中的临床研究

目的探讨两阶段法远端胃切除+D2淋巴结清扫在胃窦癌根治术中的临床疗效。方法回顾性分析76例因胃窦癌行远端胃切除+D2淋巴结清扫的胃癌患者的临床病理资料,根据其手术方案不同随机分为两阶段法手术组和常规手术组。统计2组手术时间、淋巴结清扫个数、手术出血量、住院时间、术后并发症和5年生存率。结果两阶段法手术组较常规手术组手术时间、手术出血量明显减少,但淋巴结清扫个数、住院时间、术后并发症和5年生存率和与常规手术组比较,差异无统计学意义。结论应用两阶段手术进行远端胃切除+D2淋巴结清扫可显著缩短胃窦癌根治术的手术时间,减少出血量,并保证手术根治性与疗效。     

Laparoscopic stomach‐partitioning gastrojejunostomy in preparation for distal gastrectomy and Billroth‐II reconstruction after neoadjuvant chemotherapy for advanced gastric cancer with gastric outlet obstruction: A case report

Gastrojejunostomy has been performed as a palliative treatment for unresectable, advanced gastric cancer patients with gastric outlet obstruction (GOO). However, its role before neoadjuvant chemotherapy (NAC) has not been established. We present the case of a 72‐year‐old man with distal advanced gastric cancer with GOO. Computed tomography showed para‐aortic lymph node (PAN) metastasis without other distal metastasis. We performed laparoscopic stomach‐partitioning gastrojejunostomy (LSPGJ), which avoided new gastrojejunostomy reconstruction when performing distal gastrectomy after NAC. His oral intake improved after surgery and NAC was successfully administered on postoperative day 14, without surgical complications. After completion of NAC, the patient underwent radical distal gastrectomy with gastrojejunostomy reused as Billroth‐II reconstruction. A histological examination revealed no residual cancer cells. LSPGJ, with partitioning on the expected resection line in distal gastrectomy after NAC, can be useful for treating advanced gastric cancer with GOO when NAC followed by curative gastrectomy is planned.     

A new oval multichannel port to facilitate reduced port distal gastrectomy

Background: This report describes the techniques and outcomes of reduced port distal gastrectomy (RPDG) using a new oval multichannel port. Material and methods: We performed reduced port distal gastrectomy through the E·Z Access? oval type device with three trocars in the umbilical incision, plus the use of additional 5 mm and 2 mm ports. All routine procedures performed in conventional laparoscopic distal gastrectomy (CLDG) were achieved in RPDG. Results: We employed this technique without the use of additional trocars or conversion to laparotomy in all 25 patients. The median length of the operation was 340 (range, 220–487) minutes, and the median estimated blood loss was 30 (range, 5–440) ml. Neither major postoperative complications, such as anastomotic leakage and stricture, nor postoperative mortality were observed. The mean length of the hospital stay was 11 days. The umbilical wound was indistinct. The patients were also highly satisfied with the cosmetic outcome. Conclusion: Reduced port surgery using the E·Z Access? oval type device was successfully applied for gastric cancer. This method is technically feasible, produces superior cosmetic results and thus could be an attractive surgical option for gastric cancer patients.     

胃癌根治术中的医源性脾损伤防治

目的 探讨胃癌根治术中医源性脾损伤防治方法。方法回顾性分析本科5年来420例胃癌根治术中出现14例医源性脾损伤的临床资料。结果根治性远端胃大部切除、近端胃大部切除和全胃切除中,分别发生脾损伤8例、4例、2例。脾损伤按Pachter分级,Ⅰ级3例、Ⅱ级9例、Ⅲ级2例。经电凝加医用生物蛋白胶止血、大网膜缝合、明胶海绵压迫止血3例,缝合修补术9例,全脾切除2例。全组均痊愈出院。结论胃癌根治术导致的医源性脾损伤的发生,与术式相关,通过提高认识、改进操作、妥善处理,这种损伤是可以预防或降到最低限度的。     

Risk factors for esophagojejunal anastomotic leakage after curative total gastrectomy combined with D2 lymph node dissection for gastric cancer

ObjectiveTo explore the risk factors associated with esophagojejunal anastomotic leakage (EJAL) after curative total gastrectomy combined with D2 lymph node dissection for gastric cancer.MethodsWe reviewed the data for 390 consecutive patients undergoing Roux-en-Y esophagojejunostomy reconstruction after total gastrectomy. Multivariate analysis was performed using a logistic regression model to identify the independent risk factors for EJAL.ResultsOf the 390 patients enrolled in this study, EJAL occurred in 10 patients (2.6%), and one patient (1/10) with EJAL died. Univariate analysis identified age, alcohol consumption, pulmonary insufficiency, and intraoperative blood loss as risk factors for EJAL. Of these four risk factors, age and alcohol consumption were retained as independent risk factors by multivariate analysis.ConclusionSurgeons should be very careful regarding anastomotic leakage after esophagojejunal anastomosis, perioperatively, especially in patients with advanced age and a history of alcohol consumption. Pulmonary insufficiency and intraoperative blood loss, although not identified as independent risk factors, should also be considered.     

老年进展期胃癌的外科治疗

胃癌是我国死亡率最高的恶性肿瘤之一,随着人口老龄化,老年患者逐渐增多。根治性手术是治愈进展期胃癌的唯一手段:D2胃癌根治术作为治疗进展期胃癌的标准术式已被普遍接受。几项临床试验已证实与D2根治术相比,扩大手术范围并未使患者术后生存率有更多的获益。为改善进展期胃癌患者的预后,必须强调开展术前TNM分期,以便临床医师根据肿瘤的状况选择合适的治疗方案。微创外科技术在进展期胃癌中的应用仍有争议,需要进一步研究。胃癌术后消化道重建方式是决定术后生活质量的关键因素,理想的重建方式仍有争议。     

远端胃癌根治术后不置胃管及早饮水的可行性和安全性研究

目的：探讨远端胃癌根治术后不置胃管及早饮水的安全性和可行性。方法将100例行远端胃癌根治术的患者根据手术先后顺序随机分为对照组和观察组各50例。对照组采用外科术后护理常规,予以安置胃管,禁食、禁饮,保留胃管至肛门排气、排便后再进食水;观察组除外科护理常规外,不安置胃管,术后6h患者麻醉完全清醒后,在医生指导下协助患者每4h饮一次温开水,每次10～20ml,对两组患者术后肠功能恢复时间、下床活动时间、腹胀、呼吸道感染、吻合口瘘等因素进行分析。结果观察组术后肠功能恢复时间短、下床时间早,差异具有显著意义（P＜0．05）;观察组术后咽喉疼痛、肺部感染发生率低,两组差异具有显著意义（P＜0．05）;两组术后恶心呕吐、吻合口瘘、腹胀发生的差异无显著意义（P＞0．05）。结论远端胃癌根治术后不置胃管及早饮水是安全可行的,可促进肠功能的恢复及减少术后并发症,提高患者舒适度,有利于病人术后的恢复。     

胃癌根治术65例临床分析

目的提高进展期胃癌手术治愈率。方法回顾性分析2005年1月至2008年1月间我院施行的胃癌根治术65例。结果中早期胃癌6例（9．23％），进展期胃癌59例（90．76％）。D2术患者45例，绝对根治（淋巴结清扫范围大于淋巴结转移范围）率57．78％（26／45），D3术患者20例，绝对根治率80％（16／20）。结论有选择性的施行D3术对提高进展期胃癌生存率是合理和必要的。     

Results of the surgical therapy of stomach cancer

1589 patients treated between 1965 and 1985 at the First Surgical Department of Vienna University were investigated to answer the following questions: 1. Development of postoperative mortality. 2. Is a palliative gastrectomy indicated? 3. Does gastrectomy en principe improve survival? 4. Quality of life after total gastrectomy. Postoperative mortality after distal resection was decreased from 8% to 1.2%. After total gastrectomy mortality was reduced from 20% to 4.3%. A significant factor in this improvement was the use of Y-Roux reconstruction as the only method during recent years. After palliative resections the mortality was not higher than in curative operations. Comparison of comparable tumour stages of the mid stomach revealed no benefit of gastrectomy over distal resection in terms of survival. This was found to apply to both cases of negative and positive lymph node involvement as well. Gastrectomy en principe does not seem to improve survival rates. The quality of life after total gastrectomy (Y-Roux) is satisfactory in most patients. Dumping and reflux were rare, diarrhoea occurred in 22%, anaemia in 30% of patients.     

腹腔镜胃癌D2根治术无瘤技术的临床应用研究

目的探讨并研究腹腔镜下行胃癌全胃切除（D2）根治术中无瘤技术的临床应用效果。方法选取2010年4月至2013年4月收治的进展期胃癌患者共42例作为研究对象,所有患者均行腹腔镜下胃癌根治术,观察并记录患者手术疗效、病理结果及随访情况,总结并分析术中无瘤技术的应用效果。结果所有患者均成功完成腹腔镜手术及术中的淋巴结清扫,无吻合口瘘、十二指肠残端瘘、吻合1：2梗阻等并发症发生。共清扫12组淋巴结平均（3．80±1．25）枚,其中癌转移平均为（1．30±0．13）枚,所有患者肿瘤近、远残端病理检查均未发现癌细胞。术后随访患者均健康生存,复查增强CT等均未发现肿瘤复发、远处转移等情况。结论腹腔镜下行胃癌根治术在术中严格遵守无瘤原则,能够获得令人满意的手术近期效果,而其远期效果尚需进一步多中心大宗病例的随机对照研究结果。随着腹腔镜技术不断发展、抑制肿瘤的药物研制、无瘤技术的改善,腹腔镜下行D2胃癌根治术的应用会有更为广阔的临床应用空间。     

Laparoscopic total gastrectomy for advanced gastric cancer in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a rare congenital anomaly. Generally, laparoscopic surgery is difficult to perform in patients with SIT because of both the potential challenges associated with unexpected vascular anomalies and the lack of standardized strategy for handling such cases. This is the first report of laparoscopic total gastrectomy with lymph node dissection for advanced gastric cancer in a patient with SIT. A 79‐year‐old man with SIT was diagnosed with advanced gastric cancer. We performed laparoscopic total gastrectomy with modified D2 lymph node dissection (D2 without splenectomy) and esophagojejunal anastomosis using an overlap method involving retrocolic Roux‐en‐Y reconstruction. The total operating time was 232 min, and blood loss was 110 mL. There were no postoperative complications. In summary, laparoscopic total gastrectomy for gastric cancer can be performed safely, even in a patient with SIT.     

Early gastric cancer with splenic artery aneurysm successfully treated with laparoscopic distal gastrectomy after endovascular coil embolization: A case report

Splenic artery aneurysm (SAA) is a relatively rare disease. Most patients with SAA have no symptoms, and detection is incidental detection. The incidence of rupture is not particularly high, but the mortality rate of ruptured SAAs is high. The main treatment for gastric cancer is gastrectomy with lymph node dissection, with dissection around the celiac artery suggested to be the most important. A 68-year-old woman with early gastric cancer in the lesser curvature of the lower gastric corpus was referred to our hospital. CT showed no remarkable findings except for a saccular SAA (diameter, 1.5 cm). We planned laparoscopic distal gastrectomy. However, because the SAA was close to the surgical field and its saccular shape created a rupture risk, we performed interventional radiology for SAA before surgery. One month later, laparoscopic distal gastrectomy with D1+ was performed successfully. The patient has remained disease-free in the 51 months since the operation.     

术中联合胃镜测漏对预防胃癌患者术后吻合口并发症的影响

目的 对比术中联合胃镜的充气测漏和亚甲蓝测漏技术对胃癌根治术患者术后吻合口并发症的影响.方法 回顾性分析2017年9月-2019年9月南充市中心医院207例行胃癌根治术患者的临床和病理资料.根据是否使用术中测漏(IOLT),将患者分为IOLT组和无术中测漏(NIOLT)组.术中测漏包括胃镜检查、充气测漏和亚甲蓝测漏.分...     

腹腔镜辅助远端胃癌根治术165例效果观察

目的:探讨腹腔镜辅助远端胃癌根治术患者治疗效果及围术期护理方法.方法:将330例胃癌患者分为实验组和对照组各165例,实验组行腹腔镜辅助远端胃癌根治术,对照组行开腹远端胃癌根治术,均给予精心围术期护理.比较分析两组术后恢复情况及疼痛程度.结果:实验组术后疼痛程度、下床活动时间、进食时间、肛门排气、排便时间、拔除胃管时间、平均住院时间及并发症发生率与对照组比较差异有统计学意义(P均<0.05).结论:腹腔镜辅助远端胃癌根治术具有手术创伤小、术后恢复快、并发症发生率低等优点,加强围术期护理有利于患者康复.     

远端胃癌D2根治术Billroth-Ⅰ式、Billroth-Ⅱ式和Roux-en-Y式重建的术后恢复效果比较

目的 比较远端胃癌D2根治术Billroth-Ⅰ式、Billroth-Ⅱ式和Roux-en-Y式重建的术后恢复效果.方法 将2014年1月至2018年12月收治的60例远端胃癌D2根治术患者以简单随机化法分为A、B、C组,每组20例.A组接受术后Billroth-Ⅰ式消化道重建,B组接受术后Billroth-Ⅱ式消化道...